* § 3234. Limitations on administrative services and stop-loss
coverage. No insurer, subsidiary of an insurer, or controlled person of
a holding company system may act as an administrator or claims paying
agent, as opposed to an insurer, on behalf of a group which denies or
limits benefits for a specific disease or condition or for a procedure
or treatment unique to a specific disease or condition in a manner which
would be inconsistent with this chapter or regulations promulgated by
the superintendent had the group purchased insurance. No insurer,
subsidiary of an insurer, or controlled person of a holding company may
provide stop loss, catastrophic or reinsurance coverage to groups which
deny or limit benefits for a specific disease or condition or for a
procedure or treatment unique to a specific disease or condition in a
manner which would be inconsistent with this chapter or regulations
promulgated by the superintendent had the group purchased insurance. A
limit, maximum, or other mechanism that controls total coverage without
regard to a specific disease or condition shall not be deemed one that
denies or limits benefits for a specific disease or condition, or for a
procedure or treatment unique to a specific disease or condition.
Nothing herein shall be construed to mandate the inclusion of specified
benefits in an employer group plan, if such plan is not subject to the
provisions of this chapter.
* NB There are 2 § 3234's
Structure New York Laws
Article 32 - Insurance Contracts - Life, Accident and Health, Annuities
3201 - Approval of Life, Accident and Health, Credit Unemployment, and Annuity Policy Forms.
3202 - Withdrawal of Approval of Policy Forms.
3205 - Insurable Interest in the Person; Consent Required; Exceptions.
3206 - Policies Which Provide for an Adjustable Maximum Rate of Interest on Policy Loans.
3208 - Antedating of Life Insurance Policies and Burial Agreements Prohibited.
3209 - Life Insurance, Annuities and Funding Agreements Disclosure Requirements.
3210 - Incontestability After Reinstatement.
3212 - Exemption of Proceeds and Avails of Certain Insurance and Annuity Contracts.
3214 - Interest Upon Proceeds of Life Insurance Policies and Annuity Contracts.
3215 - Disability Benefits in Connection With Life Insurance and Annuities.
3216 - Individual Accident and Health Insurance Policy Provisions.
3217-A - Disclosure of Information.
3217-C - Primary and Preventive Obstetric and Gynecologic Care.
3217-D - Grievance Procedure and Access to Specialty Care.
3217-E - Choice of Health Care Provider.
3217-F - Prohibition on Lifetime and Annual Limits.
3217-G - Maternal Depression Screenings.
3217-H - Telehealth Delivery of Services.
3217-I - Essential Health Benefits Package and Limit on Cost-Sharing.
3217-J - Utilization Review Determinations for Medically Fragile Children.
3218 - Medicare Supplemental Insurance Policies.
3220 - Group Life Insurance Policies; Standard Provisions.
3221 - Group or Blanket Accident and Health Insurance Policies; Standard Provisions.
3224 - Standard Claim Forms; Accident and Health Insurance.
3224-B - Rules Relating to the Processing of Health Claims and Overpayments to Physicians.
3224-C - Coordination of Benefits.
3224-D - Prescription Synchronization.
3225 - Eligibility for Health Insurance in Cases of Exposure to Des.
3226 - Reinsurance Contracts Excepted.
3227 - Interest Upon Surrenders, Policy Loans and Other Funds.
3228 - Individual Accident and Health Insurance Policies; Premium Refund at Death of Insured.
3229 - Minimum Benefit Standards for Certain Long Term Care Plans.
3231 - Rating of Individual and Small Group Health Insurance Policies; Approval of Superintendent.
3231*2 - Health Insurance Policies and Subscriber Contracts; Prohibited Claims.
3232 - Pre-Existing Condition Provisions in Health Policies.
3232-A - Certification of Creditable Coverage.
3233 - Stabilization of Health Insurance Markets and Premium Rates.
3234 - Pre-Existing Condition Provisions in Group and Blanket Disability Policies.
3234*2 - Limitations on Administrative Services and Stop-Loss Coverage.
3236 - Public Health Law Assessments.
3237 - Health Insurance Coverage for Full-Time Students on Medical Leaves of Absence.
3238 - Pre-Authorization of Health Care Services.
3240*2 - Student Accident and Health Insurance.
3242 - Prescription Drug Coverage.
3245 - Liability to Providers in the Event of an Insolvency.